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23D-092 (2) 1111111.111111. BP-2008-0056 GIS#: COMMONWEALTH OF MASSACHUSETTS 11111111111. CITY OF NORTHAMPTON Lot: -001 PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS Permit: Building DO NOT HAVE ACCESS TO THE GUARANTY FUND (MGL c.142A) Category: BUILDING PERMIT Permit# BP-2008-0056 Project# JS-2008-000082 Est. Cost: $6975.00 Fee: $25.00 PERMISSION IS HEREBY GRANTED TO: Const. Class: Contractor: License: Use Group: Adam Quenneville 120982 Lot Size(sq. ft.): 6185.52 Owner: MATUS DON E Zoning: URB Applicant: Adam Quenneville AT: 37 NUTTING AVE Applicant Address: Phone: Insurance: 160 OLD LYMAN RD (413) 536-5955 O Workers Compensation SOUTH HADLEYMA01075 ISSUED ON:7/18/2007 0:00:00 TO PERFORM THE FOLLOWING WORK:STRIP & SHINGLE ROOF POST THIS CARD SO IT IS VISIBLE FROM THE STREET Inspector of Plumbing Inspector of Wiring D.P.W. Building Inspector Underground: Service: Meter: Footings: Rough: Rough: House# Foundation: Driveway Final: Final: Final: Rough Frame: Gas: Fire Department Fireplace/Chimney: Rough: Oil: Insulation: Final: Smoke: Final: THIS PERMIT MAY BE REVOKED BY THE CITY OF NORTHAMPTON UPON VIOLATION OF ANY OF ITS RULES AND REGULATIONS. Certificate of Occupancy Signature: FeeType: Date Paid: Amount: Building 7/18/2007 0:00:00 $25.0010965 212 Main Street,Phone(413)587-1240,Fax: (413)587-1272 Building Commissioner-Anthony Patillo sue- 3r gisip ,. -• s"r : 7"fy- •- �� City of Northampton §i 1.7.i : i �` " .• _ �r I •� ^' Building Department . �`t�a �b�. e S '�.�' �;r�q`�� - .� • - \,+ 12 Main Street ;Q 6 t t t,01 `•Room 100 R) No tha pton, MA 01060 '11 0 is a 0'' - -,4.�• s� \L phone 4 87• 40 Fax 413-587.1272 ®t S .,e .e. y r;-. x --'- \ "may}~ _, *as 5.^..,, +� a e-,.''"' x :I ,3 i --`'ik• xr�-x APRL1 N-TO"CONSTRUCT, ALTER, REPAIR, RENOVATE OR DEMOLISH A ONE OR TWO FAMILY DWELLING F,.... ' t ;rioN,aii-•SiiT Rrri g• tYl .0114., , 4'� �i s6611, o be"compfetediiby iff►c".e _ 1.1 Property Address: ` ' .* .=.1.' `.r 4°a' �' '' g y s d " s.t. x3 ti t h € 1'," .� -. 14 , 3 " �� Lot vo Frtt . ',,I 1 t'ib 1g /) t1 Zovpligare ' `" Overlps,05 t ict �m* F , All , 1. r .tr r' �- 9. n#' 'T'u S�p� K iF`'�7k ,'�y"� .-..51 sr r3 a -,;;•.:.n k�,'��- .r,yry'.{.�' '�.i'" ,ram 4, e •S. O Q 2,-'? 4 , R r iQ E i ��UT A CZERf kx ENT: .�? '� �.�+r.+. � , }� F� �!r�gs5•iuS_ 4ii! ,acu4l , r rq.-.,.. F ��J r y r rQ - 2.1 Owner of Record: r\ 240O5LZS CL4 b.4 R - g to M 6 q73 Name(Print) Current Mailing Add . L,LS. as.-it le Telephone Signature 2.2 Authorized Agent: A,C.l C e.In k4l\,e f-r (4O O e mrxu, � Cffin o . Net Name(Print) Current Mailing Addrss: r b%5gs Signature Telephone VSIE Ti iN.3; ESaTt�d7ED GbNb'CRougatiN• Q �d�"'f - .7`:�;,,:. - .•.. .. ..,'�•f4Nj' ,.rrtl.f•1. Mi !!:Pl:a .N4..:iF:E,.9Nt4..,.. .. Item Estimated Cost(Dollars)to be ,. �ifrc_ i•U �•¶Q�•JY w:7: completed by permit applicant ` ,: .• 1. Building (a) Building Perrp3g.Fee, (�9?. 00 a� . 2. Electrical (b) Estimated ToWCost of Construction from (6) • . 3. Plumbing Building Permit Fee 4. Mechanical (HVAC) 5. Fire Protection 6. Total =(1 + 2 + 3 + 4 + 5) L 'JS.CJU Check Number /a9& }:. • This-Section,For Official Use;On'ly.. •,4.Jldtng'PernlitiON ,011i,er' ,s •• •:... _.r Date:!ssued,:. i4i�ature: P H F • • .. - }L i Bwlc i.oB:, a ;mi.ss�one,(In l e,tor�ot:B.uudir s u �,:.. .' P.te , • Section 4. - ALL INFORMATION MUST BE COMPLETED, or PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION Existing Proposed Required by Zoning This column to be filled in by Building Department Lot Size Frontage _ Setbacks Front Side L: R: L: R: Rear • Building Height Bldg. Square Footage Open Space Footage (Lot arca minus bldg&paved parking) #of Parking Spaces Fill: (volume&Location) A. Has a Special Permit/Variance/Finding ever been issued for/on the site? NO DON'T KNOW YES IF YES, date issued: IF YES: Was the permit recorded at the Registry of Deeds? NO DON'T KNOW YES IF YES: enter Book Page and/or Document # B. Does the site contain a brook, body of water or wetlands? NO DON'T KNOW YES IF YES, has a permit been or need to be obtained from the Conservation Commission? Needs to be obtained Obtained , Date Issued: C. Do any signs exist on the property? YES NO IF YES, describe size, type and location: D. Are there any proposed changes to or additions of signs intended for the property ?YES No IF-YES, describe size, type and location: • • • - j`6�'S�EL'1•T",1r.+TPri-ON S 411 rig ~ € g _ 4; , iµ rr r #anFlC:' A s S.0111, T ONTO aROPOSEDD -ORK(-cteci . L$f al:H:11 Te kikAAr�15701 i'0 "1. .101.1 awe¢�.fi w-. A.M. mmar .,,OftV1,7A =. v J.T. New House 0 Addition 0 Replacement Windows Alteration(s) 0 Roofing Or Doors 0 • Accessory Bldg. 0 Demolition❑ New Signs [ ] Decks [ ] Siding[ ] Other [ ] Brief Description of Proposed Work: S Alteration of existing bedroom Yes No Adding new bedroom Yes No Attached Narrative 0 Renovating unfinished basement Yes No Plans Attached Roll 0 - Sheet 0 ®antra o e nt tiVI: a :v am p e:, a Ll owrrr : a. Use of building : One Family Two Family Other b. Number of rooms in each family unit: Number of Bathrooms c. Is there a garage attached? d. Proposed Square footage of new construction. Dimensions e. Number of stories? f. Method of heating? Fireplaces or Woodstoves Number of each g. Energy Conservation Compliance. Mascheck Energy Compliance form attached? h. Type of construction i. Is construction within.100 ft. of wetlands? Yes No. Is construction within 100 yr. floodplain Yes No j. Depth of basement or cellar floor below finished grade k. Will building conform to the Building and Zoning regulations? Yes No I. Septic Tank City Sewer Private well City water Supply ��O�BE�CyOM,PE�T�pr1�(1��N T, otiMitfiteiy 0R 0 TERR-Mk$ PLIESi 'Of3 U( pyl cG P� '"i rttr:�,3��.'+ ��. wE§�ur � i s} � � e•:a � ,C, , as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application. Signature of Owner Date I, *ant) `'4 1/ R o , as Owner/Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge and belief. Signed under�p the pains and penalties of perjury. t- 9.Q,V`n OPev NU-ikf Print Name Signature of er/Agent Date EO pr kfloyAf $ Ei'U 7111,0N SERVICES 8.1 Licensed Construction Supervisor: Not Applicable 0 Name of License Holder : (D-O(9 ADAM License Number • QUENNEVILLE ROOFING Pa F:D'`''),'�lC. g_�l_ d Address 160 Old LyniaR Rd. Expiration Date So.Hadley,MA 01075 Signature Telephone Not Applicable 0 ear ADAM i aU cL$a Company Name QUENNEVILLE ROOFING&SIDING,INC. Registration Number 160 Old Lyman Rd. ),S- OSr— Address k . So.Hadley,MA 01075 Expiration Date Telephone `1 10 � NtatIyERS CbMP S. IONANSI)F;<ANCEIAFFIDAIIIT(M G L c 152, §25c 6r)). •ry;ViniF Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the issuance of the building permit. Signed Affidavit Attached Yes ,F)-- No 0 The current exemption for"homeowners"was extended to include Owner-occupied Dwellings of one(1) or two(2)families and to allow such homeowner to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. CMR 780, Sixth Edition Section 108.3.5.1. Definition of Homeowner:Person(s)who own a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be, a one or two family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official,on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. As acting Construction Supervisor your presence on the job site will be required from time to time, during and upon completion of the work for which this permit is issued. Also be advised that with reference to Chapter 152(Workers' Compensation) and Chapter 153 (Liability of Employers to Employees for injuries not resulting in Death)of the Massachusetts General Laws Annotated,you may be liable for person(s) you hire to perform work for you under this permit. The undersigned"homeowner"certifies and assumes responsibility for compliance with the State Building Code,City of Northampton Ordinances, State and Local Zoning Laws and State of Massachusetts General Laws Annotated. Homeowner Signature z (----- i4ttV H.h�O _Z�. �.-' � Q • lYZfll elf c:\�lTl' �jiilli�Jftllij $ 6tasaar}tusrtta' 1�`r— r m DEPARTMENT OP BUILDING INSPECTIONS , _ :_ 212 Main Street ' Municipal building • Northampton, Mass. 01060 . r'' WORKER'S COMPENSATION INSURANCE k.PFIDAV1T nn��, • • I, _ 'Y1__� `>1:2.�1naell __._.-----_-_----'----.. ._..- -- -- (liccrs.J(:crniittcc) • • with a principal place of business/residence at: . li------ -- _ �n`�1'^— --�� _(phone ). - 5 S' - (strcctici ty!statc/•rip) • do hereby certify, under the pains and penalties of perjury, that: - (Lriam an employer providing the following worker's compensation coverage for !ny employees working on this job: • • n1M frLt \ Ildo, 3-4lotaoa1 4-13-N (Insurance Conpaay) (Polies Number) (Expiration Date) ( ) I am a sole proprietor, general contractor or homeowner (circle one) and have hired the contractors listed below who have the foilo.. ing worker's compensation policies: (Name of Contractor) (Insurance Company/Policy Number) (Extort:aon Date) • • (Name of Contractor) (Lnsurancc Company/Policy Number) (Expirmioo Date) (Name of Contractor) (lnsurinc Company/Polies Numbzr) .._ (Exj.iracon Date) • (Name of Contractor) (Insurance Company/Policy Number) (Expiration Date) (much additional sheet if/woe:„y to Mehl z i tf`rms:iat,:_._.:ior,::sII o:c==r::,,1 • ( ) I am a sole proprietor and have no one 'a:orking for me. ( ) I am a home owner performing all the woe.. myself NOTE:plc-ac be aware that while hcacvtiuers t,vo employ;c:so::to,t z-mate uaec,o:aw.n:r im Cr repair„••vi: d•.c11 g of not more than area units in tti:ich the hom.tosvoor raid=cx at the p-o::3 tppsrter=thacto a.•e no(ga rally omsiti:r.:::o t` eztploycs under the worker':etsa ::aticn Act(0L!52_s 1(5)),app li:ation by a hog:teotvr,a fora ticense or perr-i:r..:.•y-...'`r-e the legal status of an amploy.r wader th4 Workers Coropemation A.c*. • I understand that a copy of this staterneca may bo forwarded to tl»Deliortamt of Industrial Accidents'Oilioe of Insuru+x for the coverage vaifierioa and that f alum to:come covtrago easier:action 25A of MOL 152 can lca<i to the imposition of criminal pecaL:a ma:aging of a fire of up to s l.So0.00 inefa'trzysisss•�s�-r of up to ere.star nisi civil Ries in t,c feces of a Stop Wcri and a • fins of r100.00 a day a .inm m:. • _.t • For tSgsartris,aNW use only Map', tunlx r I,ot _ ____ 1 • � ,..„... A D A APIIA ff .4•kd, QUEtIII EN/ILLE ELKS I_ ROOFING INC. The Premium Choice. 160 Old Lyman Road, South Hadley, MA 01075 We Are Licensed 1-800-NEW-ROOF • 413-536-5955 Insured Email:info@1800newroof.net Website:www.1800newroof.net Factory Trained MA Construction Supervisors Lic.#070626 MA Registration#120982 Factory Certified Installers Member of the Home Builder's Association of Western Mass. CT Registration#575920 Member of the Building&Trade Association Member of the Better Business Bureau P.P.C.38710 Proposal Submitted To: Date Phone#'s an /aatuS G-3.-07 H: ( S d-/(44 Cell: Street Mail To: 27 Noti-mck ker1k,e._ CH C&na NnycCA )- Ot 52; City,State,Zip C td Special Requ ments V k ePR It c/ / 1/1,/ FA4-s/j`/N G' N nR aYYIp `M Id1\T rvs'mk /vi-5: /2!P6t 1/ =/r.'/ Proposal to furnish and install the following Ell Re-Roof `, 'ear-Off ElGutter R ?�{j4^�� ��� 25 Complete Roof Preparation /Al c -t'1)BS 6.4fe.. /deer. Home exterior to be protected by tarps and plywood Shrubs, landscaping,trees to be protected Entire existing roofing material to be removed to existing decking, including flashing,etc. Site to be cleaned everyday with roll magnet debris removed at project completion Z S- -riorated existing decking replaced at$2.50 per sq.ft. : :rown 8 inch metal drip edge installed at eaves and rakes ❑ White/Brown 5 inch for re-roof only ► y le ew flashing will be installed where necessary(see Special Requirements) Install new pipe boot flashing WWe shall acquire all appropriate permits etc.for all roofing work Complete Roofing System gi ELK Leak Barrier installed at all eaves to protect from ice dams (and meet codes in the north) 41 ELK Leak Barrier installed in all valleys, around penetrations, and chimneys to protect critical areas rai 15 pd. reinforced underlayment installed over entir decking Shingles: K ELK Prestique®Series W30 year ❑ 50 year Color -/(fry/` Olt kff-y: ZI Nailable ridge vent will be installed ELK ridge cap shingles --,.. y Warranty Options: '`'~ YWe guarantee our workmanship for 5 full years ❑ ELK10-Year Umbrella Coverage Limited Warranty upgrade. - VISA Maste ' { DUC/VER ❑ ELK15-Year Umbrella Coverage Limited Warranty upgrade. L �4 We Propose hereby to furnish materials and labor-complete in accordance with above specifications for the sum of: (�( Total Sale Price$ -615. 00 Down Payment$ k-S-00. 0 0 Upon Completion$ 5 17t .00 ACCEPTANCE OF PROPOSAL The above prices,specifications and conditions are satisfactory and are hereby accepted. You are authorized to do work as specified.Payment will be 1/3 down upon signing,and balance due upon completion. Unpaid balances shall accrue with interest at 18%per annum. Purchaser(s)will pay for all costs,expenses and reason- able attorney's fees incurred by Adam Quenneville Roofing and Siding,Inc.to recover any sums due under this contract. Nte: 7-7-o? Signature: /t`: l-/ / . Phone# 66 S', Y(- ql'07 Estimator's Signature: Estimates are honored for sixty(60)days from above date 'FI3S:,Please cover all personal belongings in the attic,garage or storage areas due to the -_ '"°-:dust coming In through cracks of the wood.Adam Quenneville Roofing and Sidings 'ridust in the attic or storage areas. • • gg,e :eol'ivinowAlieirda / . a- Board of Building Regula ions and Standards =1=E= t One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Home Improvement:Contractor Registration Registration: 120982 Type: DBA Expiration: 3/25/2008 ADAM QUENNEVILLE ROOFING _ ADAM QUENNEVILLE P.O. BOX 612 SO. HADLEY, MA 01075 Update Address and return card"Mark reason for change. »s-cm 50M-04/05-PC8698 Address Renewal Employment Lost Card elk 16----204„,,,,,0„,z,t t____Azi. Board of BuildingRegulations tL= One Ashburton Place, Km 1301 = Boston, Ma 02108-1618 License: CONSTRUCTION SUPERVISOR LICENSE Birthdate: 08/21/1971 Number: CS 070626 Expires: 08/21/2007 Restricted To: 00 ADAM A QUENNEVILLE 160 OLD LYMAN RD - �' S HADLEY, MA 01075 i '�"= : Tr. no: 3761.0 v......�....inr...real nt and channo of address notification. :^G"5ii:� :•:v+::.:� rr'v;� rYiJ+ r.Ss��.rrl L+K �`✓+.4v �S•.r.V/,:,r,••.S:�V..:.v;`ti•s.:,f!:,•l Vi' rw..`V'. .Y 5, •1Vi ..4 S •ltt• '0:liJ' t �,1� Syr �y, r�N r1c� 1 r. �:. iyv�,k�, •d � >r#f ,� �•+� �'`. °"u +h� lr �,������- i, �11-;.�+4t t _( 7„�P�{!'"ij �'1. "?�'t,.3i -' '.",# 4 <ra.r 1�' >o-y4c'�: : . '.-..a ^ , 1 r !v .^`'SAY p� ; i 0. p++.,7-4 ! .t.(, r t i,• 1"Y ;y. 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J, b' x }p M r r k ti q # i" a..:"'�e�� a"�t91't'•N F.'�tlikJ' 1�._t �:��C:l�:a����'�".',.w.r�..i,.���!�y b�'_a _ �.tir•• ? c-.r 1.... of:,.t=,pf� �.�:�a'�+y�n�`3'�dS'r���±MP�i:lir"yt.4'k;+z sf ' .. 5 . RX Date/Time 06/27/2007 10: 59 1 413 538 6010 P. 001 Jun-27-2007 , 09:50 AM Remillard Insurance 1-413-538-6010 1/3 ACORD,, CERTIFICATE OF LIABILITY INSURANCE CSR RL DATE(MMIDD/YYYV) ADAMQ-1 06/27/07 PRODUCER ;, THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Remillard Insurance Agcy, Inc HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 79 Lyman Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. South Hadley MA 01075 • Phone:413-538-7862 Fax:413-538-7179 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Scottsdale Ins Co. INSURER B: AIM Hutual Insurance Company Adam Quenneville Roofing &Siding Inc INSURERC: P 0 Box 612 INSURER D; South Hadley MA 01075 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Y CYEXPIR-KrION LTR,NSRC TYPE OF INSURANCE POLICY NUMBER DATE(MMIDD/YY) DATE(MMIDDIYY) LIMITS GENERAL LIABILITY I EACH OCCURRENCE $1000000 A X COMMERCIAL GENERAL LIABILITY CLS1384198 06/23/07 06/23/08 PREMSES(Eaoccurence) $50000 CLAIMS MADE X OCCUR MED EXP(Any one person) $5000 0 PERSONAL&ADV INJURY $ 1000000 pV GENERAL AGGREGATE $2000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $ 2000000 P —PRO — POLICY LOC JEC7 AUTOMOBILE LIABILITY n COMBINED SINGLE LIMIT $ ANY AUTO / (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY I///�\ AUTO ONLY-EA ACCIDENT S ANY AUTO EA ACC S OTHER THAN AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY 0 i EACH OCCURRENCE $ OCCUR f I CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ IH- WORKERS COMPENSATION AND X TORY S IV LI MMIITS TS O ER R EMPLOYERS'LIABILITY B AWC7012861012007 04/29/07 04/29/08 E.L EACH ACCIDENT S 100000 ANY PROPRIETORMARTNER/EXECUTIVE _ — OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE 3 10 00 0 0 If yes,desc lbe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY UMIT 6500000 OTHER DESCRIPTION OF OPERATIONS!LOCATIONS!VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION fl AMHERCO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIG OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTA .. AU aU.I.Z IVE,E:" ,............._____(.7 p \---7 Step en . Radon ACORD 25(2001/08) ©ACORD CORPORATION 1988